Role of Internet in medicine

Internet, the largest network of connected computers, is becoming the ultimate frontier to access information for health providers. This review focus on how developments of this communication technology have become a useful educational resource in medicine, and describes modest ideas in computer network use. Internet basic resources are electronic mailing (E-mail), discussion groups, file transfer, and browsing the World Wide Web (WWW). E-mail brings physicians with common interest together. Surgeons employ it as a communicating tool. Legal and social responsibility is bounded with its use. Discussion groups permits debate including clinical cases, operations, techniques research, career opportunities, and meetings. File transfer provides the opportunity of retrieving archives from public libraries. The WWW is the most resourceful tool due to its friendly interface and ease of navigation. The average physician needs to know almost nothing on how computers work or where they came from to navigate through this pandemonium of information. Click and play with today graphical applications encourage the computer illiterate to connect. Establishing the connections envelops the need of hardware, software and a service provider. Future development consists of online journals with new ideas in peer-review and authentication, telemedicine progression, international chatting, and centralization of cyber space information into database or keyword search engines

Impact of minimally invasive surgery in children

An important medical technological progress of this century corresponds to the application of minimal invasive surgical techniques in adults and children. Laparoscopic surgery is causing an impact in the results of many procedures done during the pediatric age. Within this review we explore the development of laparoscopic abdominal surgery in children along with basic physiology and complications of establishing a potential working space (pneumoperitoneum). Indications, results, and where we are headed in the management of various of the most common surgical conditions of children are issues discussed. Laparoscopic surgery has proven safe, efficient, technically feasible and well tolerated in most children. Produces early return to activities, reduced hospital stay, less hospital bills, and better cosmetic results when compared to open (conventional) procedures

Trichobezoar in a 11-year old girl: a case report

Bezoars are masses of solidified organic or nonbiological material commonly found in the stomach and small bowel. Identification, therapy, and long-term management of patients with bezoars depends on accurate classification and knowledge on the pathophysiology of formation. Four types of bezoars have been described based on their composition: phytobezoars, trichobezoars, lactobezoars, and miscellaneous. Pediatric trichobezoars are associated to emotional disturbed children with aberrant appetite (trichophagia). Hair strands become retained and attached in the folds of the gastric mucosa because the friction surface is insufficient for propulsion by peristalsis. They generally are asymptomatic until enlargement produce pain, compression or intestinal obstruction. Bezoars are diagnosed with conventional radiology and gastroscopy permits identification of its nature. Currently, management of bezoars consists of: dissolution, suction, lavage, mechanical endoscopic fragmentation using pulsating jet of water, fragmentation with extracorporeal shock wave lithotripsy and surgical removal. Treatment should also focus on prevention of recurrence, since elimination of the mass will not alter the conditions contributing to their formation

Biliary atresia: an overview

Biliary Atresia is the most common cause of persistently direct (conjugated) hyperbilirubinemia in the first three months of life. It is a progressive inflammatory obliteration of the extra- and intrahepatic bile ducts whose pathogenesis remains speculative. This review updates the history, etio-pathological considerations, clinical manifestations, methods of diagnosis, surgical management, and results of this terrible disease in young infants. We will emphasize that persistent jaundice in the newborn period must be managed urgently, a diagnosis should be established early in life, and Kasai portoenterostomy offered to those infants with Biliary Atresia before their eighth week of life. This will allow more than one-third of children to survive. Hepatic transplantation is reserved for those children with failed portoenterostomy, progressive liver failure or late-referral to surgery

Neuronal intestinal dysplasia: a role for surgery?

Neuronal intestinal dysplasia (NID) is a poorly understood colonic motility disorder with characteristic histopathological findings and clinical presentation. It is often associated with Hirschsprung's disease (HD) and can constitute a cause of failure of clinical improvement after adequate resectional pull-through surgery. Other conditions associated with NID are: Chronic Intestinal Pseudo-obstruction (CIPO), anorectal malformations and Multiple Endocrine Neoplasia (MEN) II syndrome patients. To increase the diagnostic yield of NID the pathologist should be aware and use histochemistry evaluation of the rectal biopsy specimen in patients with history of constipation or unexplained bouts of diarrhea. Adequate sampling of the temporary proximal colostomy done to HD patients should be examined for NID pathological changes. Treatment has centered around the clinical picture with most cases managed medically with prokinetic agents, colonic irrigations, and bowel cathartics until improvement and normalization of histology occur. There is evidence of progressive maturation of the enteric nervous system with time. Surgery is indicated for patients with severe clinical deterioration after failed medical management

The pediatric inguinal hernia: is contralateral exploration justified?

To determine if contralateral inguinal hernia exploration is justified we decided to study our experience with 161 consecutive cases who underwent bilateral repair during a 30 months period. 61 of the population were infants younger than two years of age, and 19 premature babies. 69 pts presented with an RIH, 47 with an LIH and 45 pts with BIH. 16 suffered an episode of preoperative incarceration which were all reduced satisfactorily and operated promptly. A positive contralateral finding (either a hernial sac or a patent processus vaginalis) was identified in 74 RIH and 72 LIH patients upon exploration. No incidence of testicular edema/atrophy, vas deferens injury, or recurrence was reported in the six-year follow-up of the study. Statistical analysis of the contralateral findings during surgery with sex, gestational age and age at operation showed that females and infants younger than two months of age had a higher probability of having positive findings. We could not show that prematurity or left-sided hernias were associated with a higher positive contralateral rate. The major benefit of contralateral exploration is based on the fact that it allows discovery and elimination of a patent processus vaginalis so a hernia cannot develop subsequently. We conclude by establishing certain criteria that justifies the routine contralateral exploration of the pediatric hernia: the surgeon should be experienced in child care, associated conditions should not increase the surgical risks significantly, time-consuming dissections of the cord structures should be discouraged, and the operating time should be kept to a minimum